NC needs to build Medicaid reform on what works: community care

by Dr. David Tayloe, published in News and Observer, July 18, 2014.

The current discussion about reforming Medicaid in North Carolina and how it should be managed is an important one because the cost of caring for the Medicaid population consumes a significant portion of state budgets.

I have been in primary care pediatrics in Wayne County since 1977 and have participated in the development and maturation of the Community Care of North Carolina program. Physicians have worked side-by-side in a public-private partnership to craft a program that really works for patients and families at the community level.

A group with a vested interest in seeing Medicaid privatized is moving state by state, attempting to discredit medical home models like CCNC. While political opinions may differ about how best to develop the Medicaid program, it’s imperative that we get the facts straight.

North Carolina should build on its successful provider-led programs, including CCNC’s nationally recognized model. CCNC is a private, not-for-profit organization. In North Carolina, we have one of the highest physician participation rates in the country with more than 90 percent of primary care providers accepting Medicaid patients. These physicians built a robust statewide data and care management infrastructure over the last decade, all while keeping savings in the state. Its successful model has influenced programs in many other states, including Arkansas, Connecticut, Colorado and Idaho.

As a homegrown solution to Medicaid, CCNC saves money that remains in the state. Based on research by a firm hired by the state of North Carolina, CCNC helped the Medicaid program avoid nearly $1 billion in costs over a four-year period.

Although North Carolina, like all states, has experienced growth in the Medicaid population, Medicaid spending per-person for recipients enrolled in CCNC has declined.

CCNC is rooted in care coordinated by providers, not insurance corporations. By keeping care decisions in the hands of those most qualified to make them, medical home models improve health outcomes for North Carolina’s Medicaid population. Doctors, care managers and pharmacists across provider-led networks share data and best practices to provide efficient and high-quality care to patients, decreasing emergency room visits and reducing wasteful spending.

The CCNC model is the result of decades of work that has consistently generated positive results in North Carolina. An HMO takeover of this system would mean higher administrative costs to the state and billions of taxpayer dollars leaving the state to pay corporate shareholders. Under federal Medicaid rules, the additional money required to pay HMOs can come from only one place – sharp cuts to provider payments. When physicians choose not to participate in Medicaid, patients neglect preventive care and head to the emergency room in crisis, raising state costs while producing less positive health outcomes.

As president of the American Academy of Pediatrics (2008-2009), I had the opportunity to discuss Medicaid with pediatricians all over the country. It became obvious that CCNC is the best model available for taking good care of Medicaid patients. It concerns me that our state would scuttle a proven care model in return for a for-profit system that primarily benefits special interests outside the state.

I would hope that our leaders would go forward with cost-saving initiatives that assure CCNC will continue to provide cost-effective, high-quality care for patients who rely on Medicaid in our state. If North Carolina moves to an HMO model, doctors will leave the program, patients will have less access to care and a primary care infrastructure that is the envy of other states will be lost.

North Carolina has an important decision to make about the future of Medicaid, and entities like CCNC are a key component to a successful reform plan.

Dr. David Tayloe Jr. lives in Goldsboro.